Former Chief Medical Officer reflects on injuries in NRL

Former Chief Medical Officer for the National Rugby League (NRL), Dr Ron Muratore, outlined practices in NRL which he believes still need to change when he spoke at Warrane on Wednesday 15 April 2015.

Dr Muratore held his position with the NRL for more than six years before retiring late last year after playing a key role in supporting the NRL through key reforms, including improving the management of concussion and banning the shoulder charge.

He told Warrane residents that when he first started working as a Rugby League medical officer when he was a medical student playing at UNSW in the 1960s his first aid kit was a bucket and “old rag” or sponge.

The bucket and sponge remained in use until 1980 when he was able to get it banned, because it was obviously unhygienic and a possible source of cross infection.

The process of developing more efficient first aid had developed only slowly over the years and one of the biggest obstacles to change was the fact that some coaches were only concerned with winning matches - nothing else mattered.

“What happens with this player next week?” he asked. “They don’t care. I want to know what this player is going to be like in 10 years time.”

One of Dr Muratore’s first concerns in NRL was the code’s guidelines for concussion injuries.

He said the management of concussion has improved significantly since the 1990s when he was a team doctor. In those early days concussion was graded from Grade 1 to Grade 3. Grade 2 included a period of unconsciousness for up to two minutes, and Grade 3 included a period of unconsciousness longer than two minutes.

“I always felt that any period of unconsciousness was a severe injury,” Dr Muratore said. “The guidelines at that time were such that if a player had no symptoms - that is, had supposedly recovered - he was allowed to return to the field of play. Players were always keen to return to play, they felt that if you could run and you could tackle you could play.

“This has obviously changed especially so in the last few years. We no longer grade concussion. If a player is diagnosed as having a concussion he is not allowed to return to the field of play. This was instigated in 2011, following on the AFL doing so.”

Dr Muratore said that the treatment of concussion improved partly due to four international conferences on “Concussion in Sport”, the last of which was in Zürich in 2012. However he said players still want to continue playing and have to be educated to see that it is not brave to continue playing when you are concussed.

Another concern for Dr Muratore was the practice of encouraging players to take dietary supplements rather than helping them to eat well. He said one coach had his whole team taking 22 pills per day.

“He wouldn’t understand that it was better to teach these guys to eat properly,” he said. “Eighty-five percent of players in the NRL are taking at least one supplement or more and a lot of clubs are actually sponsored by supplement producers.

“How ethical is it to flog supplements to an 18-year-old kid when you could teach them to eat properly. Ninety percent of supplements are a placebo. If you think it’s doing you good its going to do you good. But it would be better to eat proper food.”

Another of his concerns was “punch-drunk syndrome”, or Chronic Traumatic and Encephalopathy (CTE), a condition for which there has been a lot of research and discussion in the United States, especially from a group in Boston.

“That group imply that ‘head knocks’ are the sole cause of this condition. NFL is a completely different game to ours and the aim of the game is to crash into people with your helmet. This happens a huge number of times both in training and games. Therefore players in the NFL are more prone, I believe, to brain injury. I believe they play concussed.

“I believe the condition is multifactorial. In the States in the 1960s and 70s the use of steroids was widespread, it is also not known what the drugs both illicit and legal, were taken, the amount of alcohol that players drink and the number of fights that players get into.

“CTE can only be diagnosed post-mortem therefore we must take all steps possible to prevent the condition. We cannot control what players do away from the field but we can control how we manage concussion, and head injury in general.”

Speaking about the ongoing issue of discouraging shoulder charges in League, Dr Muratore said he had had to battle people who thought the shoulder charge was “a great part of our game”.

“We have rules in place to protect the head, but you don’t have to hit the head to break someone’ neck.”

The rate of injuries from shoulder charges was seven percent, compared to only 0.1 percent for other types of tackle, so that injuries were occurring 70 times more frequently from shoulder charges.

“When people do it they don’t get punished really,” Dr Muratore said. “They call it accidental, but they should still be sent off.”

Dr Muratore said he did not enjoy the game of Rugby League as much as he used to because “they don’t play the ball anymore, they play the man.” He said change was taking place so slowly in League because people “like to talk the talk, but they don’t like to walk the walk”.

“But I think they will eventually come across,” he said. “You have to drag them screaming into the 21st century.

“I think all the doctors are basically onside, but my gut feeling is that the doctors have been overruled.”